2005-389 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
4z:t Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20050389 Date Issued: Tuesday, June 07, 2005
This is to certify that work requested to be done as shown by Permit Number P20050389
has been completed.
Tax Map Number: 523400-295-019-0002-041-000-0000
Location: 7 LYNNFIELD Dr
Owner: JAMES & FABIOLA JABAUT
Applicant: JAMES & FABIOLA JABAUT
This structure may be occupied as a:
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the r:
property owner of the responsibility for compliance with Site Plan,
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20050389 Application Number: A20050389
Tax Map No: 523400-295-019-0002-041-000-0000
Permission is hereby granted to: JAMF,S & FABIOLA JABAI IT
For property located at: 7 LYNNFIELD Dr
in the Town of Queensbury,to construct or place
at the above location in accordance with application together with plot plans and other information hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: JAWS & FABIOLA JABAUT Septic Alteration Residential
7 LYNNFIELD Ave Total Value
QUEENSBURY, NY 12804
Contractor or Builder's Name / Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2005-389
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Friday, June 02, 2006
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queenshury before the expiration date.)
Dated at the own Que buf; y, June 02, 2005
SIGNED BY /V( e for the Town of Queensbury.
Director of Building&Code Enforcement
1° s
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256
1. OWNER INFORMATION:
...................................................................................................................
...................:
Office Use
Location of installation .
7 File Permit
Tax Map No.
Owner's Name: 11-f r f'
Fee Paid :
Address: L- A A%F/ e
2. INSTALLER'S NAME ,." d >'t C1 �.._ �'G/ PHONE NO. 7 , � �7
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply#of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation = Total lDaily Flow
1980 or older _ x 150 gal/bdrm =
1980— 1991 x 130 gaUbdrm = z
1991 —present x 110 gal/bdrm = CC
CD
Garbage Grinder Installed yes_ / no
Spa or Hot Tub Installed yes_ / no AN N . 7 f 105
URY
4. PARCEL INFORMATION: (circle applicable information&indicate measure M OWN ppF AND CODE
�i��ING AND CODE
4F07aph ature Ground Water Bedrock or Im ervious Material Do Water Su 1
sand at what depth at what depthmunicipa oam feet feet
Steep slope clay if well; water supply
_%slope other from any septic-system
depth: absorption is ft.
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: minute per inch
5. PROPOSED SYSTEM: For New Construction: All individual sewage disposal systems must be designed by a licensed
professional engineer or architect(unless installed in a Planning Board approved subdivision). Add 250 gallons to the size
of the septic tank and leach figld for each Garbage Grinder,Spa or Whirlpool Tub.
Septic Tank 0 J ,J gallon (min. size 1,000 gal)
Tile Field: each trench `I`�' ft. Total System Length: 3 0
Seepage Pit(s): number of size of each: ft. by ft.
Size of Stone to be used: # 2-- / depth or thickness _feet
Bed System Size: x
Alternative System: length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: 1 Size of each: gallons /TOTAL Capacity: gallons
Note: Alarm System and associated electrical work must be inspected by a Town approved
electrical inspection agency.
7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read)
For your protection,please note that pursuant to Section 136-29 of the Code of the Town
of Queensbury, any permit or approval granted which is based upon or is granted in
reliance upon any material misrepresentation or failure to make a material fact or
circumstance known by or on behalf of an applicant, shall be void.
I have read the regulations with respect to this application and agree to abide by these and all
requirements of the Town of Q sbury Sanitary Sewage Disposal Ordinance.
i at
of respo sibie person Date
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Septic Inspection Report
Office No. (518)761-8256 Date Inspection request receiiv�ed-
Queensbury Building&Code Enforcement Arrive: am/� u—part: ' m/pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials:
NAME: J464IT, PERMIT NO.: � � �
LOCATION: INSPECT ON: �s b
RECHECK:
Comments and/or diagram
Soil Type:Typef San 1,41ay
Type of Wa er: unicip /Well Water
Waterline separate stance ft.
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches Z2 ft.
Size of Stone
See a e Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box 3
Distribution Box to Field/_Pit_
Opening Sealed: Y/N/Partial
End Cap*
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan it Y N
Engineer Report and As-Built Y N
Location of System on Property:
Front ear Left Side Right Side
Middle Fr t Middle Rear
System Use Sta s•
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
Last revised 1/6/05
4 l or
1
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: agry� „Depart: am/pm
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: p_
L
NAME: PERMIT NO.:
LOCATION: t L INSPECT ON: —r0_'��`}�
RECHECK:
Comments and/or diagram
Soil Type: Sand/Loam/Clay
Type of Water: Municipal/Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches $.
Size of Stone
Seepage Pits: Number D /
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/Pit
Opening Sealed: Y/N/Partial
End Cap*
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y N
Location of System on Property:
Front Rear Left Side Right Side
Middle Front Middle Rear
System Use Statyartilal
ved
Approved and needs to be re-inspected, please call the Building&Codes Office
proved
Last revised 1/6/05
RECEIVED
JUN X005
TOWN OF QUEENSBURY
BUILDING AND CODE
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